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Impact of positive legionella urinary antigen test on patient management and improvement of antibiotic use

¹ Division of Infectious Diseases, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland
² Clinical Virology Laboratory, Department of Internal Medicine, University of Geneva Hospitals

Correspondence to:
Dr J Garbino
Division of Infectious Diseases, Department of Internal Medicine, University of Geneva Hospitals, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland; jorge.garbino{at}hcuge.ch Aim: To assess the incidence of legionella infection over a 27 month period at a large university hospital.

Material and Methods: The present retrospective cohort study enrolled patients with legionellosis, defined as those presenting a positive urinary antigen for legionella together with a medical history, clinical findings, and radiological findings consistent with pneumonia. These patients were evaluated to determine the relation between their test results and changes in treatment modalities. A control group of patients with pneumonia but a negative urinary antigen test for legionella were also analysed.

Results: Twenty seven of 792 assessed patients tested positive for legionella. In 22 of these patients, legionella active antibiotics were administered empirically. In seven patients, the test results prompted a legionella specific treatment, whereas in 12 cases, non-specific antibiotics were stopped within 24 hours. Overall, treatment was altered in more than half of the patients as a result of the test results.

Conclusions: The urinary antigen may have a direct impact on clinical management of pulmonary legionellosis. However, patient comorbidities and individual clinical judgment are still important for determining the best treatment to be given in each individual case.

Keywords: legionella urinary antigen test; antibiotic use; cost reduction; Legionella pneumophila; macrolides